Objectives

Recent advancements in medical oncology have led to the development of multiple agents for the treatment of relapsed/refractory multiple myeloma (RRMM). These novel agents are generally given as combination therapies and have improved clinical outcomes such as progression-free survival (PFS). Given that patients are recommended for treatment till progression, this may lead to an increase in cost of treatment. The aim of this study was to compare drug treatment costs and drug cost per progression-free life year (PFLY) for the key regimens recommended for RRMM in Japan.

Methods:

List of regimens included in the analysis were based on RRMM treatment guidelines in Japan. These included doublet and triplet regimens containing the following agents: bortezomib (Bort), lenalidomide (Len), ixazomib (Ixa), panobinostat (Pano), carfilzomib (Carf), pomalidomide (Pom), elotuzumab (Elo), daratumumab (Dara), cyclophosphamide (Cyclo) and dexamethasone (Dex). Dosage, dosing schedule, duration of treatment (DOT) and PFS were obtained from published literature. Drug acquisition and administration costs were obtained from regional sources. Costs were cumulated over DOT to estimate per-patient total drug treatment cost which was then divided by PFS duration to estimate drug cost per PFLY for each regimen.

Results:

The PFS varied from 4 months (PomDex) to 46 months (DaraLenDex). Total drug treatment cost for RRMM showed a wide variation. Drug costs were below ¥10M for BortDex, PomDex, BortCycloDex, and PanBortDex, between ¥10M-¥40M for CarfDex, LenDex, DaraBortDex, IxaLenDex, CarfLenDex and EloLenDex. DaraLenDex had the maximum treatment costs (>¥65M). Drug cost per PFLY ranged from ¥3M for BortCycloDex to ¥23M for EloLenDex. Cost of triplet regimens were generally higher than that for doublet regimens.

Conclusions:

Drug treatment cost in Japan varies significantly depending upon the regimen being prescribed to a patient with RRMM. Drug treatment cost per PFLY for newer regimens, that are mostly triplets, is substantially higher than doublet regimens.